Contrave Boosts Weight Loss for Breast Cancer Survivors

Breast cancer survivors who lost 5% or less with diet and exercise saw more weight loss, improved physical function and less pain with Contrave.

Contrave (naltrexone plus buproprion) can enhance weight loss outcomes in breast cancer survivors who do not attain significant weight loss with diet and exercise modification alone; however, further research is needed to understand individuals who benefit most from pharmacotherapy, according to study findings published in the Journal of Clinical Oncology.

At six months, people in the 5% or less-behavioral weight loss (SLOW-BWL) program lost an average of 5.1% of their weight, and those in 5% or more-behavioral weight loss (FAST_BWL) lost 10.8%.

Furthermore, in SLOW-BWL, 42% reached at least 5% weight loss. Participants also had improved blood sugar levels between two and six months. For SLOW-BWL participants, every two pounds above the program’s two-month average weight change made reaching the six-month goal one third as likely. Among SLOW-BWL participants who reported on their health, 29% felt less anxious, 24% had better physical function, and 19% experienced less pain, fatigue, sleep problems and sexual difficulties.

Across both programs, people who lost more than 5% of their weight had better physical function and less pain, with the biggest improvement in pain seen in SLOW-BWL participants who lost more than 5%.

What is the Purpose of the Study?

About half of breast cancer survivors achieve 5% weight loss after six months of behavioral intervention alone. This study tested whether adding the FDA-approved anti-obesity medication Contrave to a behavioral weight loss program could help survivors who had not lost 5% of their weight after eight weeks.

The trial used a two-stage design to measure the proportion of participants achieving at least 5% weight loss at six months. Researchers also assessed physical function, hormone levels, pain, fatigue, mood, sleep and sexual health.

Trial Design

Women with stage 0 to 3 breast cancer and a body mass index greater than 27 kilograms per square meter (kg/m²)who had completed local therapy and chemotherapy were enrolled in the six-month, remotely delivered behavioral weight loss (BWL) program of the trial. All participants received the POWER-remote BWL intervention and were assigned a behavioral coach. Coaching calls occurred weekly during months one to three and monthly during months four to six. Participants completed demographic and psychosocial surveys, laboratory assessments including hemoglobin A1c and lipid panels, and were weighed in clinic at baseline, two months and six months.

An adaptive design using weight loss at two months stratified participants by likelihood of success at six months. Participants achieving 5% or more weight loss by week nine were classified as fast responders (FAST-BWL) and continued BWL alone for the remainder of the study. Participants with 5% or less weight loss were classified as slow responders (SLOW-BWL) and received Contrave in addition to BWL for at least 16 weeks, in accordance with FDA recommendations, unless 5% or more weight loss was achieved by month six. All participants continued weekly coaching calls during week nine, and symptoms potentially related to pharmacotherapy were monitored and reported to the principal investigator.

Of the 53 enrolled participants, 15 (28%) were FAST-BWL responders and 38 (72%) were SLOW-BWL responders. Compared with FAST-BWL, the SLOW-BWL group included a higher proportion of Black participants (32% versus 7%), premenopausal women (21% versus 7%), and participants with an ECOG performance status of 1 (26% versus 13%). The primary outcome was percent weight change at six months. Secondary outcomes included evaluation of obesity-related biomarkers, cardiometabolic factors and the microbiome.

Reference

1. “Pharmacotherapy as an adjunct to behavioral weight loss treatment in survivors of breast cancer,” by Dr. Jennier Y. Sheng, et al. Journal of Clinical Oncology.

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